Pain, distress, and anticipated recovery for older versus younger emergency department patients after motor vehicle collision

BMC Emergency Medicine

Research Article

Thomas J Tkacik¹  Samuel A McLean²  Timothy F Platts-Mills²  Phyllis L Hendry³  Niels K Rathlev⁴  David A Peak⁵  David C Lee⁶  Jeffrey S Jones⁷  Robert M Domeier⁸  Robert A Swor⁹  Gregory F Pereira^1,10 

[1] Department of Anesthesiology, University of North Carolina, 101 Manning Drive, CB #7010, 27599-7010, Chapel Hill, NC, USA;Department of Anesthesiology, University of North Carolina, 101 Manning Drive, CB #7010, 27599-7010, Chapel Hill, NC, USA;Departments of Emergency Medicine and Anesthesiology, University of North Carolina, 101 Manning Drive, CB #7010, 27599-7010, Chapel Hill, NC, USA;Department of Emergency Medicine and Pediatrics, University of Florida-Jacksonville, Jacksonville, FL, USA;Department of Emergency Medicine, Baystate Medical Center, Springfield, MA, USA;Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA;Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY, USA;Department of Emergency Medicine, Spectrum Health – Butterworth Campus, Grand Rapids, MI, USA;Department of Emergency Medicine, St. Joseph Mercy Hospital, Ann Arbor, MI, USA;Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, MI, USA;School of Medicine, University of Pennsylvania, Philadelphia, PA, USA;

关键词: Geriatrics;    Pain;    Emergency medicine;    Traffic accidents;   

DOI  :  10.1186/s12873-014-0025-y

 received in 2013-09-06, accepted in 2014-12-09,  发布年份 2014

来源: Springer

【 摘 要 】

BackgroundMotor vehicle collisions (MVCs) are the second most common injury mechanism resulting in emergency department (ED) visits by older adults. MVCs result in substantial pain and psychological distress among younger individuals, but little is known about the occurrence of these symptoms in older individuals. We describe the frequency of and characteristics associated with pain, distress, and anticipated time for physical and emotional recovery for older adults presenting to the ED after MVC in comparison to younger adults.MethodsIn-person interviews were conducted for adults presenting to one of eight EDs after MVC without an obvious fracture or injury requiring admission as part of two prospective studies. Pain severity was assessed using a 0–10 verbal scale. Distress was assessed using the Peritraumatic Distress Inventory (range 0–52). Patients were asked to estimate their expected time for physical and emotional recovery; these responses were dichotomized to <30 or ≥30 days. ED pain and distress and associations between patient and collision characteristics and ED pain and distress were examined for patients age 65 years and older and patients age 18 to 64.ResultsOlder (n = 96) and younger (n = 943) adults had the same mean pain scores (5.5, SD 2.5 vs. 5.5, SD 2.4). Distress scores were lower in older than in younger adults (15.5, SD 9 vs. 19.2, SD 10). A higher percentage of older adults than younger adults had an anticipated time to physical recovery ≥30 days (41%, 95% confidence interval [CI] 28%-55% vs. 11%, 95% CI 9%-13%). Similarly, older adults were more likely to have an anticipated time for emotional recovery ≥30 days (45%, 95% CI 35%-55% vs. 17%, 95% CI 15%-20%). Older adults were less likely than younger adults to have moderate or severe neck pain (score ≥4) (25%, 95% CI 23% to 41% vs. 54%, 95% CI 48% to 60%) or back pain (31%, 95% CI 23% to 46% vs. 56%, 95% CI 51 to 62%) but more likely to have moderate or severe chest pain (42%, 95% CI 32% to 50% vs. 20%, 95% CI 16 to 23%). Pre-MVC depressive symptoms and pain catastrophizing were positively associated with pain and distress in both older and younger adults.ConclusionsIn our cohort, older adults who presented to the ED after MVC experienced similar pain severity as younger patients and less distress but were more likely to estimate their times for physical and emotional recovery to be 30 days or more. Increased emergency provider awareness of acute pain and distress symptoms among older patients experiencing MVC may improve outcomes for these patients.

【 授权许可】

Unknown   
© Pereira et al.; licensee BioMed Central. 2014. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.